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Abstract: PO2324

Effect of Removing Race Coefficient (RC) from Estimated Glomerular Filtration Rate (eGFR) Among Black Adults in the US Military Health System (MHS)

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Oliver, James D., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Khan, Munziba T., Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
  • Banaag, Amanda, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
  • Koyama, Alain, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Background

The use of race in calculating eGFR is under scrutiny as a possible contributor to healthcare disparities in the US. Using the MHS electronic medical record, we evaluated the effect in Black adults of removing eGFR race adjustment on the overall prevalence of chronic kidney disease (CKD) and on the prevalence at specific levels of eGFR important in clinical decision-making.

Methods

Fiscal Year (FY) 2015 data were extracted from the MHS Data Repository for individuals of Black race aged ≥18 without end-stage kidney disease. eGFR was calculated from serum creatinine using the CKD-EPI equation both with and without adjustment for Black race. CKD was defined as having the most recent eGFRs in the FY persistently <60 mL/min/1.73m2 for more than 3 months (KDIGO criteria). Statistical significance was determined by chi-square.

Results

136,934 Black individuals (age=43±14 years, 38% female, 40% active duty) had serum creatinine measured a total of 259,930 times. With RC, mean eGFR was 98.1±25.7, 4.5% had at least one eGFR <60, and 1.3% met CKD by KDIGO criteria (Table). Removal of RC decreased mean eGFR to 84.7±22.2 (△=−13.5±3.6) and increased CKD prevalence to 2.1% (△=+68%). Without RC, 0.9% of those with GFR≥60 were reclassified as having CKD stage 3 and 5.6% of those with CKD stage 3 reclassified into CKD stages 4-5. Without RC the prevalence of CKD stages 3b-5 increased by 75%, of CKD stages 4-5 by 65%, and of eGFR<20 (eligible for transplant listing) by 71%. Among active duty, removal of RC increased prevalence of CKD by 102% and of CKD stages 3b-5 by 68%.

Conclusion

Removal of the RC resulted in significant reclassification from non-CKD to CKD and from lower to higher stages of CKD. Consequences for patient education, treatment decisions, resource utilization, and clinical outcomes may benefit from further study. The views expressed in this abstract are those of the authors and do not reflect official policy of the Departments of Army/Navy/Air Force, Department of Defense, Department of Health and Human Services, or the US Government.

Funding

  • Other U.S. Government Support